亚低温对不同中医证型心肺复苏术后患者的疗效及预后研究

A study on the prognosis and effect of mild hypothermia on CPR patientswith different TCM syndromes

目的:探讨亚低温对不同中医证型心肺复苏术后(Post-cardiopulmonary Resuscitation)患者的疗效及预后.方法:将2016年6月-2019年6月佛山市中医院重症医学科收治的心跳骤停心肺复苏后患者按照中医证型分组,所有患者均按照指南给予高级生命支持,并且联合亚低温治疗,疗程为48 h.分析比较治疗前后的凝血功能、急性生理与慢性健康-II(APACHE-II)评分、序贯器官衰竭估计评分法(Sequential Organ Failure Assessment,SOFA)评分、血清炎症因子,统计患者7 d病死率和总住院病死率.结果:治疗后两组患者血清血清活化部分凝血活酶时间(Activated Partial Thromboplastin Time,APTT)、凝血酶原时间(Prothrombin Time,PT)、凝血酶时间(Thrombin Time,TT)均较治疗前升高(P<0.05),且治疗后实证组低于虚证组(P<0.05);治疗后两组患者血清血清肿瘤坏死因子-α(Tumor Necrosis Factor Receptor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-1β(Interleukin-1β,IL-1β)水平以及APACHE-II评分、SOFA评分均较治疗前降低(P<0.05),且治疗后实证组低于虚证组(P<0.05);实证组的7 d病死率和总住院病死率显著低于虚证组(P<0.05).结论:亚低温治疗可以改善心跳骤停心肺复苏术后患者的炎症反应和预后,但是实证组患者改善较虚证组更明显.

Objective:To explore the effect and prognosis of mild hypothermia on CPR patients with different TCM syndromes.Methods:Patients with cardiac arrest and cardiopulmonary resuscitation admitted to the Department of Intensive Medicine of Foshan TCM Hospital from June 2016 to June 2019 were grouped according to TCM syndromes.All patients were given advanced life support according to the guidelines with mild hypothermia treatment.The course of treatment is 48 hours.Results:APTT,PT,and TT in the two groups were higher than before treatment(P<0.05),and those in the Shizheng(实证)group after treatment were lower than the Xuzheng(虚证)group(P<0.05).After treatment,the serum TNF-α,IL-6 and IL-1βlevels,APACHE-II score,SOFA score were lower than before treatment(P<0.05),and those in the Shizheng group after treatment were lower than the Xuzheng group(P<0.05).In the Shizheng group,the 7 days mortality and total hospital mortality rate were significantly lower than the Xuzheng group(P<0.05).Conclusion:Mild hypothermia can improve the inflammatory response and prognosis of patients after cardiac arrest and cardiopulmonary resuscitation,but the improvement in the Shizheng group is more obvious than the Xuzheng group.